title: Prevalence, characteristics, and outcomes of HIV-positive women diagnosed with invasive cancer of the cervix in Kenya.
abstract: OBJECTIVE
  To determine the prevalence of invasive cervical cancer (ICC) and assess access to, and outcomes of, treatment for ICC among HIV-infected women in Kisumu, Kenya.
  
  
  METHODS
  We performed a retrospective chart review to identify women diagnosed with ICC between October 2007 and June 2012, and to examine the impact of a change in the referral protocol. Prior to June 2009, all women with ICC were referred to a regional hospital. After this date, women with stage IA1 disease were offered treatment with loop electrosurgical excision procedure (LEEP) in-clinic.
  
  
  RESULTS
  Of 4308 women screened, 58 (1.3%) were diagnosed with ICC. The mean age at diagnosis was 34years (range, 22-50years). Fifty-four (93.1%) women had stage IA1 disease, of whom 36 (66.7%) underwent LEEP, 7 (12.9%) had a total abdominal hysterectomy, and 11 (20.4%) had unknown or no treatment. At 6, 12, and 24months after LEEP, 8.0% (2/25), 25.0% (6/24), and 41.2% (7/17) of women had a recurrence of cervical intraepithelial neoplasia 2 or worse, respectively.
  
  
  CONCLUSIONS
  Most HIV-positive women diagnosed with ICC through screening had early-stage disease. The introduction of LEEP in-clinic increased access to treatment; however, recurrence was high, indicating the need for continued surveillance.
authors.affiliation: Doris Duke Clinical Research Fellow, University of California San Francisco, San Francisco, USA. Electronic address: chemtai.mungo@ucsf.edu.
authors.forename: Chemtai
authors.initials: C
authors.lastname: Mungo
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.forename: May
authors.initials: M
authors.lastname: Maloba
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Huchko
mesh_terms: D000328:Adult; D004598:Electrosurgery / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006297:Health Services Accessibility; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007630:Kenya / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D015995:Prevalence; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*
keywords: Cervical cancer screening; HIV; Kenya; Loop Electrosurgical Excision Procedure; Resource-limited settings